ABSTRACT
Context: Recombinant human thyrotropin (rhTSH) is currently not Food and Drug Administration approved for the treatment of high-risk patients with differentiated thyroid cancer (DTC). Objective: The goal of our study was to compare the outcomes in higher-risk patients with metastatic DTC prepared for radioiodine (RAI) therapy with rhTSH vs thyroid hormone withdrawal (THW). Methods: A retrospective chart review was performed of patients with metastatic DTC in follow-up at MedStar Washington Hospital Center and MedStar Georgetown University Hospital from 2009 to 2017. Patients were divided according to their preparation for RAI therapy, with assessment of progression-free survival (PFS) and overall survival (OS). Results: Fifty-five patients with distant metastases (16 men, 39 women) were prepared for RAI therapy exclusively either with rhTSH (n = 27) or with THW (n = 28). There were no statistically significant differences between the groups regarding clinicopathological features and history of RAI therapies. The median follow-up time for patients with rhTSH-aided therapies was 4.2 years (range, 3.3-5.5 years) and for patients with THW-aided therapies was 6.8 years (range, 4.2-11.6 years) (Pâ =â .002). Multivariate analysis showed that the method of thyrotropin stimulation was not associated with a difference in PFS or OS. Conclusion: As has been shown previously for low-risk DTC, this study indicates that the mode of preparation for RAI therapy does not appear to influence the outcomes of patients with metastatic DTC. PFS and OS were similar for patients with THW-aided or rhTSH-aided RAI therapies.
ABSTRACT
Objectives: The present study is aimed at estimating patient flow dynamic parameters and requirement for hospital beds. Second, the effects of age and gender on parameters were evaluated. Patients and Methods: In this retrospective cohort study, 987 COVID-19 patients were enrolled from SMS Medical College, Jaipur (Rajasthan, India). The survival analysis was carried out from February 29 through May 19, 2020, for two hazards: Hazard 1 was hospital discharge, and Hazard 2 was hospital death. The starting point for survival analysis of the two hazards was considered to be hospital admission. The survival curves were estimated and additional effects of age and gender were evaluated using Cox proportional hazard regression analysis. Results: The Kaplan Meier estimates of lengths of hospital stay (median = 10 days, IQR = 5-15 days) and median survival rate (more than 60 days due to a large amount of censored data) were obtained. The Cox model for Hazard 1 showed no significant effect of age and gender on duration of hospital stay. Similarly, the Cox model 2 showed no significant difference of age and gender on survival rate. The case fatality rate of 8.1%, recovery rate of 78.8%, mortality rate of 0.10 per 100 person-days, and hospital admission rate of 0.35 per 100,000 person-days were estimated. Conclusion: The study estimates hospital bed requirements based on median length of hospital stay and hospital admission rate. Furthermore, the study concludes there are no effects of age and gender on average length of hospital stay and no effects of age and gender on survival time in above-60 age groups.
